Ιατρικά Άρθρα Αλέξανδρος Γ. Σφακιανάκης: 11/07/17

Τρίτη 7 Νοεμβρίου 2017

Intravoxel Incoherent Motion Analysis of Abdominal Organs: Application of Simultaneous Multislice Acquisition.

Purpose: The aim of this study was to systematically evaluate the accuracy of quantitative intravoxel incoherent motion (IVIM) analysis of the upper abdomen applying simultaneous multislice (SMS) diffusion-weighted imaging (DWI) to reduce acquisition time. Materials and Methods: Diffusion-weighted imaging of parenchymal abdominal organs was performed in 8 healthy volunteers at 3 T using a standard DWI sequence (acceleration factor 1 [AF1]) and an SMS-accelerated echo planar imaging sequence with acceleration factors 2 and 3 (AF2/AF3). Intravoxel incoherent motion analysis was performed with a multistep algorithm for true diffusion coefficient (Dt), pseudodiffusion coefficient (D*), and fraction of perfusion (Fp) measured for the liver, kidney cortex and medulla, pancreas, spleen, and erector spinae muscle. Qualitative and quantitative parameters were compared using a repeated measurement 1-way analysis of variance test and the Bonferroni post hoc method. Results: Simultaneous multislice DWI provided diagnostic image quality in all volunteers with a reduction of scan time of 50% for AF2 (67% for AF3) compared with the standard sequence. Decent IVIM analysis for Dt, D*, and Fp can be calculated on the images of both the SMS sequences AF2 and AF3 with typical organ characteristics of IVIM; however, systematical deviations from AF1 were observed: Dt values increased and Fp decreased significantly with higher acceleration factor for liver, kidney, pancreas, and muscle (P

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Recipe for a Successful Hybrid Academic-Community Radiology Practice

Publication date: Available online 7 November 2017
Source:Academic Radiology
Author(s): Kaela L. Gusenbauer, Michael N. Patlas, Ania Z. Kielar, Douglas S. Katz

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Development and application of mass spectrometric techniques for ultra-trace determination of 236U in environmental samples-A review

Publication date: 1 December 2017
Source:Analytica Chimica Acta, Volume 995
Author(s): Wenting Bu, Jian Zheng, Michael E. Ketterer, Sheng Hu, Shigeo Uchida, Xiaolin Wang
Measurements of the long-lived radionuclide ²³⁶U are an important endeavor, not only in nuclear safeguards work, but also in terms of using this emerging nuclide as a tracer in chemical oceanography, hydrology, and actinide sourcing. Depending on the properties of a sample and its neutron irradiation history, ²³⁶U/²³⁸U ratios from different sources vary significantly. Therefore, this ratio can be treated as an important fingerprint for radioactive source identification, and in particular, affords a definitive means of discriminating between naturally occurring U and specific types of anthropogenic U. The development of mass spectrometric techniques makes it possible to determine ultra-trace levels of ²³⁶U in environmental samples.In this paper, we review the current status of mass spectrometric approaches for determination of ²³⁶U in environmental samples. Various sample preparation methods are summarized and compared. The mass spectrometric techniques emphasized herein are thermal ionization mass spectrometry (TIMS), inductively coupled plasma mass spectrometry (ICP-MS) and accelerator mass spectrometry (AMS). The strategies or principles used by each technique for the analysis of ²³⁶U are described. The performances of these techniques in terms of abundance sensitivity and detection limit are discussed in detail. To date, AMS exhibits the best capability for ultra-trace determinations of ²³⁶U. The levels and behaviors of ²³⁶U in various environmental media are summarized and discussed as well. Results suggest that ²³⁶U has an important, emerging role as a tracer for geochemical studies.

Graphical abstract

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Intravoxel Incoherent Motion Analysis of Abdominal Organs: Application of Simultaneous Multislice Acquisition.

Is dose de-escalation possible in sarcoma patients treated with enlarged limb sparing resection?

To evaluate the impact of dose de-escalation in a large series of resected limbs soft tissue sarcomas (STS).

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Quantitative Perfusion Analysis of the Rectum Using Golden-Angle Radial Sparse Parallel Magnetic Resonance Imaging: Initial Experience and Comparison to Time-Resolved Angiography With Interleaved Stochastic Trajectories

Objectives: Purpose of this study was to compare the quality of perfusion maps obtained from prototypical free-breathing magnetic resonance imaging (MRI) with continuous golden-angle radial sampling and iterative reconstruction (GRASP) to conventional acquisition using time-resolved angiography with interleaved stochastic trajectories (TWIST) in patients with rectal cancer. Material and Methods: Forty cases were included for retrospective analysis. Twenty of the patients received routine multiparametric MRI at 3 T for rectal cancer staging, including perfusion measurement with GRASP or TWIST (10 patients for each technique, including 5 prechemoradiation and 5 postchemoradiation). Twenty patients without history of rectal disease served as control group (10 GRASP, 10 TWIST). GRASP images were reconstructed at temporal resolution of 3.45 seconds (21 spokes/frame). A voxel-by-voxel deconvolution approach was used to determine rectal plasma flow (mL/100 mL per minute). Regions of interest were placed at 3 levels within the tumor and normal rectum (lower, middle, and upper part). The quality of morphologic images, perfusion maps, and arterial input function were scored by 2 blinded radiologists. Independent t tests were applied. Results: Three patients of the TWIST control group had to be excluded due to technical failure of the sequence. Significantly higher scores for the perfusion maps and arterial input functions (total cohort) were obtained using GRASP (P

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Intravoxel Incoherent Motion: Model-Free Determination of Tissue Type in Abdominal Organs Using Machine Learning

Purpose: For diffusion data sets including low and high b-values, the intravoxel incoherent motion model is commonly applied to characterize tissue. The aim of the present study was to show that machine learning allows a model-free approach to determine tissue type without a priori assumptions on the underlying physiology. Materials and Methods: In 8 healthy volunteers, diffusion data sets were acquired using an echo-planar imaging sequence with 16 b-values in the range between 0 and 1000 s/mm2. Using the k-nearest neighbors technique, the machine learning algorithm was trained to distinguish abdominal organs (liver, kidney, spleen, muscle) using the signal intensities at different b-values as training features. For systematic variation of model complexity (number of neighbors), performance was assessed by calculation of the accuracy and the kappa coefficient (κ). Most important b-values for tissue discrimination were determined by principal component analysis. Results: The optimal trade-off between model complexity and overfitting was found in the range between K = 11 to 13. On "real-world" data not previously applied to optimize the algorithm, the k-nearest neighbors algorithm was capable to accurately distinguish tissue types with best accuracy of 94.5% and κ = 0.92 reached for intermediate model complexity (K = 11). The principal component analysis showed that most important b-values are (with decreasing importance): b = 1000 s/mm2, b = 970 s/mm2, b = 750 s/mm2, b = 20 s/mm2, b = 620 s/mm2, and b = 40 s/mm2. Applying a reduced set of 6 most important b-values, still a similar accuracy was achieved on the real-world data set with an average accuracy of 93.7% and a κ coefficient of 0.91. Conclusions: Machine learning allows for a model-free determination of tissue type using intra voxel incoherent motion signal decay curves as features. The technique may be useful for segmentation of abdominal organs or distinction between healthy and pathological tissues.

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Magnetic Resonance Lymphography at 9.4 T Using a Gadolinium-Based Nanoparticle in Rats: Investigations in Healthy Animals and in a Hindlimb Lymphedema Model

Objectives: Magnetic resonance lymphography (MRL) in small animals is a promising but challenging tool in preclinical lymphatic research. In this study, we compared the gadolinium (Gd)-based nanoparticle AGuIX with Gd-DOTA for interstitial MRL in healthy rats and in a chronic rat hindlimb lymphedema model. Materials and Methods: A comparative study with AGuIX and Gd-DOTA for interstitial MRL was performed in healthy Lewis rats (n = 6). For this purpose, 75 μL of 3 mM AGuIX (containing 30 mM Gd-DOTA side residues) and 75 μL 30 mM Gd-DOTA were injected simultaneously in the right and left hindlimbs. Repetitive high-resolution, 3-dimensional time-of-flight gradient recalled echo MRL sequences were acquired over a period of 90 minutes using a 9.4 T animal scanner. Gadofosveset-enhanced MR angiography and surgical dissection after methylene blue injection served as supportive imaging techniques. In a subsequent proof-of-principle study, AGuIX-based MRL was investigated in a hindlimb model of chronic lymphedema (n = 4). Lymphedema of the right hindlimbs was induced by means of popliteal and inguinal lymphadenectomy and irradiation with 20 Gy. The nonoperated left hindlimbs served as intraindividual controls. Six, 10, and 14 weeks after lymphadenectomy, MRL investigations were performed to objectify lymphatic reorganization. Finally, skin samples of the lymphedematous and the contralateral control hindlimbs were analyzed by means of histology and immunohistochemistry. Results: AGuIX-based MRL resulted in high-resolution anatomical depiction of the rodent hindlimb lymphatic system. Signal-to-noise ratio and contrast-to-noise ratio of the popliteal lymph node were increased directly after injection and remained significantly elevated for up to 90 minutes after application. AGuIX provided significantly higher and prolonged signal intensity enhancement as compared with Gd-DOTA. Furthermore, AGuIX-based MRL demonstrated lymphatic regeneration in the histopathologically verified chronic lymphedema model. Collateral lymphatic vessels were detectable 6 weeks after lymphadenectomy. Conclusions: This study demonstrates that AGuIX is a suitable contrast agent for preclinical interstitial MRL in rodents. AGuIX yields anatomical imaging of lymphatic vessels with diameters greater than 200 μm. Moreover, it resides in the lymphatic system for a prolonged time. AGuIX may therefore facilitate high-resolution MRL-based analyses of the lymphatic system in rodents.

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Somatotopic Fascicular Lesions of the Brachial Plexus Demonstrated by High-Resolution Magnetic Resonance Neurography

Objectives: The aim of this study was to evaluate whether high-resolution brachial plexus (BP) magnetic resonance neurography (MRN) is capable of (1) distinguishing patients with compressive neuropathy or noncompressive plexopathy from age- and sex-matched controls, (2) discriminating between patients with compressive neuropathy and noncompressive plexopathy, and (3) detecting spatial lesion patterns suggesting somatotopic organization of the BP. Materials and Methods: Thirty-six patients (50.9 ± 12.7 years) with clinical symptoms, nerve conduction studies, and needle electromyography findings suggestive of brachial plexopathy and 36 control subjects matched for age and sex (50.8 ± 12.6 years) underwent high-resolution MRN of the BP. Lesion determination and localization was performed by 2 blinded neuroradiologists at the anatomical levels of the plexus trunks and cords. Results: By applying defined criteria of structural plexus lesions on high-resolution MRN, all patients were correctly rated as affected, whereas 34 of 36 controls were correctly rated as unaffected by independent and blinded reading from 2 neuroradiologists with overall good to excellent interrater reliability. In all cases, plexopathies with a compressive etiology (n = 12) were correctly distinguished from noncompressive plexopathies with inflammatory origin (n = 24). Pathoanatomical contiguity of lesion from trunk into cord level allowed recognition of distinct somatotopical patterns of fascicular involvement, which correlated closely with the spatial distribution of clinical symptoms and electrophysiological data. Conclusions: Brachial plexus MRN is highly accurate for differentiating patients with symptomatic plexopathy from healthy controls and for distinguishing patients with compressive neuropathy and noncompressive plexopathy. Furthermore, BP MRN revealed evidence for somatotopic organization of the BP. Therefore, as an addition to functional information of electrodiagnostic studies, anatomical information gained by BP MRN may help to improve the efficiency and accuracy of patient care.

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The Diagnostic Value of 3-Dimensional Sampling Perfection With Application Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) MRI in Evaluating Lower Extremity Deep Venous Thrombus

Objectives: The aim of this study was to evaluate the diagnostic performance of noncontrast magnetic resonance imaging utilizing sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) in detecting deep venous thrombus (DVT) of the lower extremity and evaluating clot burden. Materials and Methods: This prospective study was approved by the institutional review board. Ninety-four consecutive patients (42 men, 52 women; age range, 14–87 years; average age, 52.7 years) suspected of lower extremity DVT underwent ultrasound (US) and SPACE. The venous visualization score for SPACE was determined by 2 radiologists independently according to a 4-point scale (1–4, poor to excellent). The sensitivity and specificity of SPACE in detecting DVT were calculated based on segment, limb, and patient, with US serving as the reference standard. The clot burden for each segment was scored (0–3, patent to entire segment occlusion). The clot burden score obtained with SPACE was compared with US using a Wilcoxon test based on region, limb, and patient. Interobserver agreement in assessing DVT (absent, nonocclusive, or occlusive) with SPACE was determined by calculating Cohen kappa coefficients. Results: The mean venous visualization score for SPACE was 3.82 ± 0.50 for reader 1 and 3.81 ± 0.50 for reader 2. For reader 1, sensitivity/specificity values of SPACE in detecting DVT were 96.53%/99.90% (segment), 95.24%/99.04% (limb), and 95.89%/95.24% (patient). For reader 2, corresponding values were 97.20%/99.90%, 96.39%/99.05%, and 97.22%/95.45%. The clot burden assessed with SPACE was not significantly different from US (P > 0.05 for region, limb, patient). Interobserver agreement of SPACE in assessing thrombosis was excellent (kappa = 0.894 ± 0.014). Conclusions: Non–contrast-enhanced 3-dimensional SPACE magnetic resonance imaging is highly accurate in detecting lower extremity DVT and reliable in the evaluation of clot burden. SPACE could serve as an important alternative for patients in whom US cannot be performed.

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Contrast Media Research 2017 Durango, Colorado USA, October 22–25, 2017 Convener: Michael F. Tweedle, PhD

No abstract available

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Ventilation measured on clinical 4D-CBCT: Increased ventilation accuracy through improved image quality

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Kasper R. Jensen, Carsten Brink, Olfred Hansen, Uffe Bernchou
Background and purposeVentilation measured on 4D cone-beam computed tomography (CBCT) using deformable image registration (DIR) may predict specific radiation sensitivity, but the measurement is affected by the current image quality. With 4D computed tomography (CT) measured ventilation acting as a gold standard the current study investigates if image improvements increase the accuracy of 4D-CBCT measured ventilation.Material and methodsThe study consists of 4D-CBCT and 4D-CT scans of 20 non-small-cell lung cancer patients. Raw CBCT projections were subjected to a standard or an improved projection correction and reconstructed by the common FDK-algorithm or the more advanced SART-algorithm. Ventilation was measured as Jacobians calculated from DIR and the comparison between CBCT and CT was done by Spearman correlation.ResultsA significant increase in the mean correlation was observed when combining improved projection correction and SART reconstruction (0.34) compared to the clinical standard (0.21). The correlation further increased when averaging ventilation measured from three successive CBCT scans (0.38).ConclusionThe study showed that the combination of improved projection correction and the SART reconstruction increased the accuracy of CBCT ventilation and this result can be a stepping stone to extract dynamic changes in respiration pattern of patients during radiotherapy.

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Association between treatment planning and delivery factors and disease progression in prostate cancer radiotherapy: Results from the TROG 03.04 RADAR trial

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Marco Marcello, Martin Ebert, Annette Haworth, Allison Steigler, Angel Kennedy, David Joseph, James Denham
Background and purposeTo evaluate the impact of treatment planning and delivery factors on treatment outcome as measured by post-treatment disease progression.Materials and methodsAccruing 813 external beam radiotherapy participants during 2003–2007, the RADAR trial collected a comprehensive range of clinical treatment factor data for each participant. Both the Fine and Gray competing risks modelling and the Kaplan–Meier (KM) analysis were undertaken to determine the impact of these factors on local-composite progression (LCP), with 709 participants available for analysis.ResultsParticipants with treatments involving 7 or more beams experienced significantly higher incidence of LCP, with a sub-hazard ratio (relative to 3-beam participants) of 3.056 (CI: 1.446–6.458, p < 0.0034). Participants treated with a more rigorous dose calculation algorithm also displayed significantly higher incidence of LCP, with a sub-hazard ratio of 1.686 (CI: 1.334–2.132, p < 0.0001). The KM analysis resulted in the same groups showing a higher incidence of LCP, with log-rank test results of p = 0.0005 and p = 0.0008 respectively.ConclusionsThe RADAR dataset has enabled a successful secondary analysis in which the impact of technical modifications has been assessed, challenging several established hypotheses. Increasingly precise treatments should be complemented with increasing accuracy to avoid potential geometric miss.

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Clustering of multi-parametric functional imaging to identify high-risk subvolumes in non-small cell lung cancer

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Aniek J.G. Even, Bart Reymen, Matthew D. La Fontaine, Marco Das, Felix M. Mottaghy, José S.A. Belderbos, Dirk De Ruysscher, Philippe Lambin, Wouter van Elmpt
Background and purposeWe aimed to identify tumour subregions with characteristic phenotypes based on pre-treatment multi-parametric functional imaging and correlate these subregions to treatment outcome. The subregions were created using imaging of metabolic activity (FDG-PET/CT), hypoxia (HX4-PET/CT) and tumour vasculature (DCE-CT).Materials and methods36 non-small cell lung cancer (NSCLC) patients underwent functional imaging prior to radical radiotherapy. Kinetic analysis was performed on DCE-CT scans to acquire blood flow (BF) and volume (BV) maps. HX4-PET/CT and DCE-CT scans were non-rigidly co-registered to the planning FDG-PET/CT. Two clustering steps were performed on multi-parametric images: first to segment each tumour into homogeneous subregions (i.e. supervoxels) and second to group the supervoxels of all tumours into phenotypic clusters. Patients were split based on the absolute or relative volume of supervoxels in each cluster; overall survival was compared using a log-rank test.ResultsUnsupervised clustering of supervoxels yielded four independent clusters. One cluster (high hypoxia, high FDG, intermediate BF/BV) related to a high-risk tumour type: patients assigned to this cluster had significantly worse survival compared to patients not in this cluster (p = 0.035).ConclusionsWe designed a subregional analysis for multi-parametric imaging in NSCLC, and showed the potential of subregion classification as a biomarker for prognosis. This methodology allows for a comprehensive data-driven analysis of multi-parametric functional images.

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Post-radiochemotherapy PET radiomics in head and neck cancer – The influence of radiomics implementation on the reproducibility of local control tumor models

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Marta Bogowicz, Ralph T.H. Leijenaar, Stephanie Tanadini-Lang, Oliver Riesterer, Martin Pruschy, Gabriela Studer, Jan Unkelbach, Matthias Guckenberger, Ender Konukoglu, Philippe Lambin
PurposeThis study investigated an association of post-radiochemotherapy (RCT) PET radiomics with local tumor control in head and neck squamous cell carcinoma (HNSCC) and evaluated the models against two radiomics software implementations.Materials and methods649 features, available in two radiomics implementations and based on the same definitions, were extracted from HNSCC primary tumor region in 18F-FDG PET scans 3 months post definitive RCT (training cohort n = 128, validation cohort n = 50) and compared using the intraclass correlation coefficient (ICC). Local recurrence models were trained, separately for both implementations, using principal component analysis (PCA) and the least absolute shrinkage and selection operator. The reproducibility of the concordance indexes (CI) in univariable Cox regression for features preselected in PCA and the final multivariable models was investigated using respective features from the other implementation.ResultsOnly 80 PET radiomic features yielded ICC > 0.8 in the comparison between the implementations. The change of implementation caused high variability of CI in the univariable analysis. However, both final multivariable models performed equally well in the training and validation cohorts (CI > 0.7) independent of radiomics implementation.ConclusionThe two post-RCT PET radiomic models, based on two different software implementations, were prognostic for local tumor control in HNSCC. However, 88% of the features was not reproducible between the implementations.

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Prognostic impact of RITA expression in patients with anal squamous cell carcinoma treated with chemoradiotherapy

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Franz Rödel, Kerstin Steinhäuser, Nina-Naomi Kreis, Alexandra Friemel, Daniel Martin, Ulrike Wieland, Margret Rave-Fränk, Panagiotis Balermpas, Emmanouil Fokas, Frank Louwen, Claus Rödel, Juping Yuan
BackgroundRBP-J interacting and tubulin-associated protein (RITA) has been identified as a negative regulator of the Notch signalling pathway and its deregulation is involved in the pathogenesis of several tumour entities. RITA's impact on the response of anal squamous cell carcinoma (SCC) to anticancer treatment, however, remains elusive.Materials and methodsIn our retrospective study immunohistochemical evaluation of RITA was performed on 140 pre-treatment specimens and was correlated with clinical and histopathologic characteristics and clinical endpoints cumulative incidence of local control (LC), distant recurrence (DC), disease-free survival (DFS) and overall survival (OS).ResultsWe observed significant inverse correlations between RITA expression and tumour grading, the levels of HPV-16 virus DNA load, CD8 (+) tumour infiltrating lymphocytes and programmed death protein (PD-1) immunostaining. In univariate analyses, elevated levels of RITA expression were predictive for decreased local control (p = 0.001), decreased distant control (p = 0.040), decreased disease free survival (p = 0.001) and overall survival (p < 0.0001), whereas in multivariate analyses RITA expression remained significant for decreased local control (p = 0.009), disease free survival (p = 0.032) and overall survival (p = 0.012).ConclusionThese data indicate that elevated levels of pretreatment RITA expression are correlated with unfavourable clinical outcome in anal carcinoma treated with concomitant chemoradiotherapy.

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With or without consolidation chemotherapy using cisplatin/5-FU after concurrent chemoradiotherapy in stage II–III squamous cell carcinoma of the esophagus: A propensity score-matched analysis

Publication date: Available online 6 November 2017
Source:Radiotherapy and Oncology
Author(s): Yongshun Chen, Liying Guo, Xinyu Cheng, Jun Wang, Yougai Zhang, Yi Wang, Shaobo Ke, Wei Shi
Background and purposeThe benefit of consolidation chemotherapy for locally advanced squamous cell carcinoma of the esophagus is unknown. The aim of this study was to investigate the efficacy of consolidation chemotherapy with cisplatin and 5-fluorouracil (5-FU) after concurrent chemoradiotherapy (CCRT) with the same agents in patients with stage II–III disease.Material and methodsData for patients with stage II–III squamous cell carcinoma of the esophagus treated with CCRT were retroactively reviewed. Patients who received CCRT alone (observation group) were compared with those who underwent CCRT followed by consolidation chemotherapy (consolidation group) with regard to progression-free survival, overall survival, treatment failure and toxicity. Differences in baseline characteristics were adjusted using the propensity score matching method.ResultsFrom September 2006 to September 2012, 812 patients were recruited (n = 272 for observation; n = 540 for consolidation). Among them, 290 (35.7%) had clinical stage II disease and 522 (64.3%) had stage III disease. In the overall study cohort, the median progression-free survival (22.1 months vs. 22.0 months, P = 0.917) and median overall survival (33.8 months vs. 31.3 months, P = 0.591) were comparable between the observation group and consolidation group. Comparisons of the observation and consolidation group in the matched population (262 patients in each group) showed median progression-free survival of 23.0 months and 25.4 months (hazard ratio [HR], 0.93; 95% CI [confidence interval], 0.74–1.15; P = 0.491), and median overall survival of 34.6 months and 35.0 months (HR, 0.92; 95% CI, 0.80–1.27; P = 0.919), respectively. There were no significant differences in local/regional failure and persistence disease (50.4% vs. 48.5%) and distant failure (10.7% vs. 8.8%) between the two groups.ConclusionsCompared to CCRT alone, consolidation chemotherapy did not further prolong progression-free survival and overall survival for patients with stage II–III squamous cell carcinoma of the esophagus. The role of consolidation therapy needs to be studied further.

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Rapid Iododeboronation with and without Gold Catalysis: Application to Radiolabelling of Arenes.

Rapid Iododeboronation with and without Gold Catalysis: Application to Radiolabelling of Arenes.

Chemistry. 2017 Nov 06;:

Authors: Webster S, O'Rourke KM, Fletcher C, Pimlott S, Sutherland A, Lee AL

Abstract
Radiopharmaceuticals incorporating radioactive iodine in combination with SPECT imaging play a key role in nuclear medicine, with applications in drug development and disease diagnosis. Despite this importance, there are relatively few general methods for incorporating radioiodine into small molecules. Here we describe a rapid, air- and moisture-stable ipso-iododeboronation procedure using NIS, in the non-toxic and green solvent dimethyl carbonate. The fast reaction and mild conditions of the gold-catalysed method led to the development of a highly efficient process for radiolabelling of arenes, which constitutes the first example of an application of homogenous gold catalysis to selective radiosynthesis. This has been exemplified with an effective synthesis of radiolabelled meta-[125I]iodobenzylguanidine, a radiopharmaceutical used for the imaging and therapy of human norepinephrine transporter-expressing tumours.

PMID: 29105856 [PubMed - as supplied by publisher]

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Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine.

Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine.

Leukemia. 2017 Nov 06;:

Authors: Molenaar RJ, Pleyer C, Radivoyevitch T, Sidana S, Godley A, Advani AS, Gerds AT, Carraway HE, Kalaycio M, Nazha A, Adelstein D, Nasr C, Angelini D, Maciejewski JP, Majhail N, Sekeres MA, Mukherjee S

Abstract
Exposure to ionizing radiation increases the risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), but such risks are not known in well-differentiated thyroid cancer (WDTC) patients treated with radioactive iodine (RAI). A total of 148 215 WDTC patients were identified from Surveillance Epidemiology and End Results (SEER) registries between 1973 and 2014, of whom 54% underwent definitive thyroidectomy and 46% received adjuvant RAI. With a median follow-up of 6.6 years, 77 and 66 WDTC patients developed MDS and MPN, respectively. Excess absolute risks for MDS and MPN from RAI treatment when compared to background rates in the US population were 6.6 and 8.1 cases per 100 000 person-years, respectively. Compared to background population rates, relative risks of developing MDS (3.85 [95% CI, 1.7-7.6]; P=0.0005) and MPN (3.13 [1.1-6.8]; P=0.012) were significantly elevated in the second and third year following adjuvant RAI therapy, but not after thyroidectomy alone. The increased risk was significantly associated with WDTC size >2 cm or regional disease. Development of MDS was associated with shorter median overall survival in WDTC survivors (10.3 vs 22.5 years; P<0.001). These data suggest that RAI treatment for WDTC is associated with increased risk of MDS with short latency and poor survival.Leukemia accepted article preview online, 06 November 2017. doi:10.1038/leu.2017.323.

PMID: 29104287 [PubMed - as supplied by publisher]

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Oral and maxillofacial manifestations of chronic kidney disease-mineral and bone disorder: a multicenter retrospective study.

Oral and maxillofacial manifestations of chronic kidney disease-mineral and bone disorder: a multicenter retrospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Oct 10;:

Authors: Pontes FSC, Lopes MA, de Souza LL, Dos Santos da Mata Rezende D, Santos-Silva AR, Jorge J, da Silva WG, Pires FR, Rocha AC, de Campos WG, Caldato MCF, Martin RM, Fonseca FP, Pontes HAR

Abstract
OBJECTIVE: To describe the oral and maxillofacial manifestations of patients diagnosed with chronic kidney disease-mineral and bone disorders.
STUDY DESIGN: Over a 13-year period, clinicopathologic data of patients diagnosed with CKD-MBD who had oral and maxillofacial alterations were retrieved from the files of 4 Brazilian institutions. Data included clinical, radiographic, microscopic, and biochemical findings; treatment employed; and follow-up status.
RESULTS: Twenty-one cases were identified, with 13 patients diagnosed as brown tumor of hyperparathyroidism (BTH) and 8 as osteitis fibrosa/renal osteodystrophy (OF/RO) (4 of them clinically consistent with Sagliker syndrome). The mean age was 32.7 years, and the mandible was the most affected site (42.8%). OF/RO had an ill-defined "ground glass" radiographic appearance, and BTH produced well-defined radiolucent images. Biochemically the following mean values were obtained: parathormone 1511.07 pg/mL, calcium 9.25 mg/dL, phosphorus 5.19 mg/dL, alkaline phosphatase 941.55 U/L, urea 125.42 mg/dL, and creatinine 7.14 mg/dL. Treatment comprised vitamin D and calcium intake, parathyroidectomy, hemodialysis, renal transplantation, and local surgery. During follow-up, 5 patients with BTH were free of lesions, whereas 2 affected by OF/RO/Sagliker syndrome died.
CONCLUSIONS: Oral and maxillofacial manifestations of BTH and OF/RO are uncommon, but they can be associated with an important life-threatening scenario.

PMID: 29104033 [PubMed - as supplied by publisher]

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An unusual microscopic pattern of foreign body reaction as a complication of dry socket management.

An unusual microscopic pattern of foreign body reaction as a complication of dry socket management.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 31;:

Authors: Tasoulas J, Daskalopoulos A, Droukas C, Nonni A, Nikitakis NG

Abstract
Foreign body reactions in the oral cavity are relatively common, frequently resulting from iatrogenic causes. Depending on the nature of the foreign material, various microscopic patterns may be observed, causing diagnostic difficulties. Recognition of the ensuing unusual microscopic pattern, especially for cases in which the possibility of a foreign body reaction is not entertained in the clinical differential diagnosis, necessitates sufficient degree of suspicion, familiarization with the spectrum of microscopic appearances, and careful clinicopathologic correlation. Medicated dressings of various compositions are commonly placed for prevention or management of dry socket (or alveolar osteitis, a common postoperative complication of tooth extraction) and may be a cause of foreign body reaction. Here, we report a foreign body reaction to a medical dressing material in a postextraction socket, with an unusual microscopic pattern bearing resemblance to parasitic infestation.

PMID: 29104032 [PubMed - as supplied by publisher]

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Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate.

Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov;124(5):464-471

Authors: Rivero JA, Shamji O, Kolokythas A

Abstract
A significant complication of radiotherapy to the head and neck for cancer treatment is osteoradionecrosis (ORN) of the jaws. The management of ORN can be complex and often requires a multimodality approach. Nonsurgical treatments with or without adjunct measures and surgical interventions have all been employed on the basis of staging of the disease process. New theories on the pathophysiology of ORN have led to the identification of novel treatment modalities, including pharmacologic management using pentoxifylline, tocopherol, and clodronate (together referred to as "Pentoclo"). In this review article, we discuss the definition and staging of ORN, its etiology and pathophysiology, and traditional treatment options and present the available information on pentoxifylline, tocopherol, and clodronate and their use in combined therapy for ORN. Limited studies to date have demonstrated the effective pharmacologic use of Pentoclo in treating ORN and radiation-induced injury at other body sites. Further research is necessary to elucidate any potential role for the use of Pentoclo in the management of this debilitating disease process.

PMID: 29103566 [PubMed - in process]

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Detection Rates of Ductal Carcinoma in Situ with Biannual Digital Mammography Screening: Radiologic Findings Support Pathologic Model of Tumor Progression.

Detection Rates of Ductal Carcinoma in Situ with Biannual Digital Mammography Screening: Radiologic Findings Support Pathologic Model of Tumor Progression.

Radiology. 2017 Nov 06;:170673

Authors: Weigel S, Khil L, Hense HW, Decker T, Wellmann J, Heidrich J, Sommer A, Heidinger O, Heindel W

Abstract
Purpose To compare detection rates of ductal carcinoma in situ (DCIS), classified according to nuclear grade, between the prevalence round (baseline screening) and two subsequent screening rounds of a population-based digital mammography screening program, to assess differences over time. Materials and Methods The cancer registry provided data for 1970 graded pure DCIS cases from 16 screening regions of the prevalence round (baseline screening, from 2005 to 2008), first subsequent round, and second subsequent round; the interval between all screening rounds was 22-30 months. Age-adjusted logistic regression analysis was performed to compare the grade-specific detection rates between the prevalence round (reference) and subsequent screening rounds. Results Over all screening rounds, cancer detection rates were lowest for low-grade DCIS (range, 0.11 [58 of 508 817 patients] to 0.25 [178 of 713 867 patients] per 1000 women screened) and highest for high-grade DCIS (range, 0.53[271 of 508 817 patients] to 0.59 [237 of 398 944 patients] per 1000 women screened). Detection rates for low-grade DCIS were significantly lower in the first (odds ratio [OR] = 0.45, P < .001) and second (OR = 0.57, P < .001) subsequent screening rounds compared with that in the prevalence round; the relative reduction of detection rates of intermediate-grade DCIS was less pronounced (OR = 0.79, P = .006 and OR = 0.76, P = .003, respectively). Conversely, the detection rate of high-grade DCIS remained at the high level found in the prevalence screening (OR = 0.89, P = .143 and OR = 0.97, P = .700, respectively). Conclusion The findings demonstrate persistently high detection rates of high-grade DCIS in two consecutive subsequent screening rounds compared with the prevalence round; conversely, rates of low-grade DCIS and, less markedly, intermediate-grade DCIS decreased in subsequent rounds. Grade-related changes of DCIS detection are suggestive of distinct dynamics of lesion progression. (©) RSNA, 2017.

PMID: 29106821 [PubMed - as supplied by publisher]

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MR neurography in intraosseous median nerve entrapment.

MR neurography in intraosseous median nerve entrapment.

World J Radiol. 2017 Oct 28;9(10):400-404

Authors: Aggarwal A, Jana M, Kumar V, Srivastava DN, Garg K

Abstract
Intraosseous entrapment of the median nerve is an uncommon complication of elbow dislocation and fractures. The condition is seen to occur in adolescent age group with a remote history of trauma. We report two rare cases of type 2 intraosseous median nerve entrapment. Though the diagnosis of median neuropathy is made with clinical tests and neurophysiological studies, however exact site of entrapment and presurgical mapping of nerve is done accurately with MR neurography. Imaging thus plays a pivotal role in management of this condition.

PMID: 29104742 [PubMed]

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Lymph node imaging in initial staging of prostate cancer: An overview and update.

Lymph node imaging in initial staging of prostate cancer: An overview and update.

World J Radiol. 2017 Oct 28;9(10):389-399

Authors: Zarzour JG, Galgano S, McConathy J, Thomas JV, Rais-Bahrami S

Abstract
Accurate nodal staging at the time of diagnosis of prostate cancer is crucial in determining a treatment plan for the patient. Pelvic lymph node dissection is the most reliable method, but is less than perfect and has increased morbidity. Cross sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive tools that rely on morphologic characteristics such as shape and size of the lymph nodes. However, lymph nodes harboring metastatic disease may be normal sized and non-metastatic lymph nodes may be enlarged due to reactive hyperplasia. The optimal strategy for preoperative staging remains a topic of ongoing research. Advanced imaging techniques to assess lymph nodes in the setting of prostate cancer utilizing novel MRI contrast agents as well as positron emission tomography (PET) tracers have been developed and continue to be studied. Magnetic resonance lymphography utilizing ultra-small super paramagnetic iron oxide has shown promising results in detection of metastatic lymph nodes. Combining MRL with diffusion-weighted imaging may also improve accuracy. Considerable efforts are being made to develop effective PET radiotracers that are performed using hybrid-imaging systems that combine PET with CT or MRI. PET tracers that will be reviewed in this article include [(18)F]fluoro-D-glucose, sodium [(18)F]fluoride, [(18)F]choline, [(11)C]choline, prostate specific membrane antigen binding ligands, [(11)C]acetate, [(18)F]fluciclovine, gastrin releasing peptide receptor ligands, and androgen binding receptors. This article will review these advanced imaging modalities and ability to detect prostate cancer metastasis to lymph nodes. While more research is needed, these novel techniques to image lymph nodes in the setting of prostate cancer show a promising future in improving initial lymph node staging.

PMID: 29104741 [PubMed]

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Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging.

Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging.

World J Radiol. 2017 Oct 28;9(10):371-388

Authors: Mormina E, Petracca M, Bommarito G, Piaggio N, Cocozza S, Inglese M

Abstract
The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique's advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson's and Alzheimer's disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance.

PMID: 29104740 [PubMed]

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Viral sequences in human cancer.

Viral sequences in human cancer.

Virology. 2017 Nov 03;513:208-216

Authors: Cantalupo PG, Katz JP, Pipas JM

Abstract
We have developed a virus detection and discovery computational pipeline, Pickaxe, and applied it to NGS databases provided by The Cancer Genome Atlas (TCGA). We analyzed a collection of whole genome (WGS), exome (WXS), and RNA (RNA-Seq) sequencing libraries from 3052 participants across 22 different cancers. NGS data from nearly all tumor and normal tissues examined contained contaminating viral sequences. Intensive computational and manual efforts are required to remove these artifacts. We found that several different types of cancers harbored Herpesviruses including EBV, CMV, HHV1, HHV2, HHV6 and HHV7. In addition to the reported associations of Hepatitis B and C virus (HBV & HCV) with liver cancer, and Human papillomaviruses (HPV) with cervical cancer and a subset of head and neck cancers, we found additional cases of HPV integrated in a small number of bladder cancers. Gene expression and mutational profiles suggest that HPV drives tumorigenesis in these cases.

PMID: 29107929 [PubMed - as supplied by publisher]

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Impaired math achievement in patients with acute vestibular neuritis.

Impaired math achievement in patients with acute vestibular neuritis.

Neuropsychologia. 2017 Oct 28;:

Authors: Moser I, Vibert D, Caversaccio MD, Mast FW

Abstract
Broad cognitive difficulties have been reported in patients with peripheral vestibular deficit, especially in the domain of spatial cognition. Processing and manipulating numbers relies on the ability to use the inherent spatial features of numbers. It is thus conceivable that patients with acute peripheral vestibular deficit show impaired numerical cognition. Using the number Stroop task and a short math achievement test, we tested 20 patients with acute vestibular neuritis and 20 healthy, age-matched controls. On the one hand, patients showed normal congruency and distance effects in the number Stroop task, which is indicative of normal number magnitude processing. On the other hand, patients scored lower than healthy controls in the math achievement test. We provide evidence that the lower performance cannot be explained by either differences in prior math knowledge (i.e., education) or slower processing speed. Our results suggest that peripheral vestibular deficit negatively affects numerical cognition in terms of the efficient manipulation of numbers. We discuss the role of executive functions in math performance and argue that previously reported executive deficits in patients with peripheral vestibular deficit provide a plausible explanation for the lower math achievement scores. In light of the handicapping effects of impaired numerical cognition in daily living, it is crucial to further investigate the mechanisms that cause mathematical deficits in acute PVD and eventually develop adequate means for cognitive interventions.

PMID: 29107735 [PubMed - as supplied by publisher]

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Eps8 expression is significantly lower in p16(+) head and neck squamous cell carcinomas (HNSCC) compared to p16(-) HNSCC.

Eps8 expression is significantly lower in p16(+) head and neck squamous cell carcinomas (HNSCC) compared to p16(-) HNSCC.

Hum Pathol. 2017 Oct 28;:

Authors: Nasri E, Wiesen LB, Knapik JA, Fredenburg KM

Abstract
In vitro head and neck cancer studies have demonstrated that epidermal growth factor receptor kinase substrate 8 (Eps8) overexpression contributes to squamous carcinogenesis. Oral squamous cell carcinoma studies have correlated Eps8 expression with metastatic disease and poor prognosis. Head and neck squamous cell carcinoma (HNSCC) studies comparing its expression by anatomic site or in in vivo regional metastases have not been performed. In this study, we compared Eps8 expression in HNSCCs arising in the oral cavity (OCSCC) and oropharynx (OPSCC) along with their corresponding regional lymph nodes (LNs) metastases. We then correlated our findings with clinicopathologic data including TNM stage, p16 status, age, gender, and smoking and alcohol history. Eps8 immunohistochemistry was performed on 69 archived OCSCCs and OPSCCs, and 24 paired and 4 unpaired LNs. Expression was scored from 0-3. Eps8 expression was detected in 49% of combined OCSCCs and OPSCCs cases. We found that expression correlated with advanced tumor stage (P=.022) and p16 status (P=.032), but not with anatomic site. Notably, p16+ HNSCCs had significantly lower Eps8 expression than p16- HNSCCs. No significant difference was observed between primary HNSCCs and their corresponding metastatic LNs. Neither p16 status nor anatomic site influenced Eps8 expression in regional LN metastases. In conclusion, our data offers in vivo support that, in HNSCCs, Eps8 is involved in tumor invasion but not necessarily the development of regional LN metastasis. The association between low Eps8 expression and p16+ HNSCCs suggests that alternative signaling pathways may be utilized for their tumorigenesis.

PMID: 29107665 [PubMed - as supplied by publisher]

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Do longus capitis and colli really stabilise the cervical spine? A study of their fascicular anatomy and peak force capabilities.

Do longus capitis and colli really stabilise the cervical spine? A study of their fascicular anatomy and peak force capabilities.

Musculoskelet Sci Pract. 2017 Oct 16;32:104-113

Authors: Kennedy E, Albert M, Nicholson H

Abstract
BACKGROUND: Longus capitis and colli are proposed to play a role in stabilising the cervical spine, targeted in clinical and research practice with cranio-cervical flexion. However, it is not clear if these muscles are anatomically or biomechanically suited to a stabilising role.
OBJECTIVES: To describe the fascicular morphology of the longus capitis and colli, and estimate their peak force generating capabilities across the individual cervical motion segments.
STUDY DESIGN: Biomechanical force modelling based on anatomical data.
METHODS: Three-part design including cadaveric dissection (n = 7), in vivo MRI muscle volume calculation from serial slices in young healthy volunteers (n = 6), and biomechanical modelling of the peak force generating capacities based on computed tomography scans of the head and neck.
RESULTS: Longus capitis and colli are small muscles spanning multiple cervical motion segments. Bilateral peak flexion torque estimates were higher in the upper cervical spine (0.5 Nm), and unlikely to affect motion below the level of C5 (<0.2 Nm). Peak shear estimates were negligible (<20 N), while peak compression estimates were small (<80 N).
CONCLUSIONS: These data highlight the complex anatomy and small force capacity of longus capitis and colli, and have implications for their function. In particular, the small peak compression forces indicate that these muscles have a limited capacity to contribute to cervical stability via traditional mechanisms. This implies that the mechanism(s) by which cranio-cervical flexion exercises produce clinical benefits is worth exploring further.

PMID: 29107220 [PubMed - as supplied by publisher]

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Immuno-metabolic determinants of chemoradiotherapy response and survival in head and neck squamous cell carcinoma.

Immuno-metabolic determinants of chemoradiotherapy response and survival in head and neck squamous cell carcinoma.

Am J Pathol. 2017 Oct 26;:

Authors: Krupar R, Hautmann MG, Pathak RR, Varier I, McLaren C, Gaag D, Hellerbrand C, Evert M, Laban S, Idel C, Sandulache V, Perner S, Bosserhoff AK, Sikora AG

Abstract
Tumor immune microenvironment and tumor metabolism are major determinants of chemoradiotherapy response. We assessed the interdependency and prognostic significance of specific immune and metabolic phenotypes in head and neck squamous cell carcinoma (HNSCC) and evaluated changes in reactive oxygen species as a mechanism of treatment response in tumor spheroid/immunocyte co-cultures. Pretreatment tumor biopsies were immunohistochemically characterized in a cohort of 73 HNSCC patients treated by definitive chemoradiotherapy and correlated with survival. The prognostic significance of CD8A, GLUT1, and COX5B gene expression were analyzed within The Cancer Genome Atlas database. HNSCC spheroids were co-cultured in vitro with peripheral blood mononuclear cells (PBMC) in the presence of the glycolysis inhibitor 2-deoxyglucose and radiation treatment followed by PBMC chemotaxis determination via fluorescence microscopy. In the chemoradiotherapy-treated HNSCC cohort mitochondrial-rich (COX5B) metabolism correlated with increased and glucose-dependent (GLUT1) metabolism with decreased intratumoral CD8/CD4 ratios. High CD8/CD4 together with mitochondrial-rich or glucose-independent metabolism was associated with improved short-term survival. The Cancer Genome Atlas analysis confirmed that patients with a favorable immune and metabolic gene signature (high CD8A, high COX5B, low GLUT1) had improved short- and long-term survival. In vitro, 2-deoxyglucose and radiation synergistically up-regulated reactive oxygen species-dependent PBMC chemotaxis to HNSCC spheroids. Our results suggest that glucose-independent tumor metabolism is associated with CD8-dominant anti-tumor immune infiltrate, and together these contribute to improved chemoradiotherapy response in HNSCC.

PMID: 29107073 [PubMed - as supplied by publisher]

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Promoter hypermethylation of SLIT2 is a risk factor and potential diagnostic biomarker for nasopharyngeal carcinoma.

Promoter hypermethylation of SLIT2 is a risk factor and potential diagnostic biomarker for nasopharyngeal carcinoma.

Gene. 2017 Oct 26;:

Authors: Li J, Zhou C, Wang G, Wang S, Ni S, Ye M, Zhang J

Abstract
SLIT2 is a candidate tumor suppressor gene and recent studies have shown that SLIT2 expression is suppressed or reduced by hypermethylation in the promoter region in various cancers. The aim of this study was to investigate the association between SLIT2 promoter methylation and nasopharyngeal carcinoma (NPC) and its relative diagnostic ability for NPC. Bisulfite pyrosequencing technology was performed to measure methylation levels of the SLIT2 promoter in tissue and plasma samples from 61 NPC patients and 38 normal volunteers. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the diagnostic ability of SLIT2 methylation for diagnosing NPC. Our results showed that methylation levels of the SLIT2 promoter were significantly higher in NPC patients compared with individuals, both in tissue samples (P=2.57E-10) and plasma samples (plasma: P=3.86E-13). In addition, the frequency of SLIT2 promoter methylation markedly increased in the advanced stage (tissue: P=3.50E-05; plasma: P=1.14E-04) and advanced T classified (tissue: P=9.00E-06; plasma: P=3.80E-05), as well as in lymph node metastasis patients (tissue: P=1.82E-03; plasma: P=2.22E-03). In addition, the AUCs according to tissue and plasma samples were 0.846 and 0.866, respectively. When these two sample-types were combined, the AUC increased slightly to 0.874. Our study revealed that elevated SLIT2 promoter methylation contributed to the risk of NPC, as well as being involved in its progression and metastasis. Therefore, the methylated SLIT2 promoter could serve as a potential biomarker for diagnosing NPC.

PMID: 29107007 [PubMed - as supplied by publisher]

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Chronic Rhinosinusitis: Endotypes, Biomarkers and Treatment Response.

Chronic Rhinosinusitis: Endotypes, Biomarkers and Treatment Response.

J Allergy Clin Immunol. 2017 Oct 26;:

Authors: Gurrola J, Borish L

Abstract
It is increasingly recognized that chronic rhinosinusitis (CRS) comprises a spectrum of different diseases with distinct clinical presentations and pathogenic mechanisms. Defining the distinct phenotypes and endotypes of CRS impacts prognosis and most importantly is necessary as the basis for making therapeutic decisions. The need for individualized defining of pathogenic mechanisms prior to initiating therapy extends to virtually all therapeutic considerations. This is clearly crucial with antibiotics where, barring an influence from their off-target anti-inflammatory pharmacological effects, an understanding of the role of individual biome predicts likelihood of therapeutic benefit. But this need for identifying individual phenotypes and endotypes also extends to the agent that is currently considered the mainstay of treatment of CRS, specifically glucocorticoids (GCS). As with asthma, it is recognized that a large minority of CRS patients have a steroid-resistant phenotype, identification of which will preclude use of these agents with their potential side effects. Identification of endotypes is also becoming increasingly imperative as targeted biotherapeutic agents, such as anti-IgE and anti-cytokine antibodies are becoming available. These agents are likely to benefit patients in whom the targeted mediator is not only expressed but demonstrably driving a central mechanism in that individual. In summary, the treatment of CRS is at an exciting crossroad. On the positive side, numerous therapeutics are in development that seem likely to positively impact our patients who suffer from this condition. The challenge is that these therapies will require targeted individualized treatments based upon identifying subjects with the relevant endotype.

PMID: 29106996 [PubMed - as supplied by publisher]

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Unexpected Extracardiac Multifocal Adult Rhabdomyomas With 10 Lesions of the Head and Neck: Epidemiology, Diagnosis, and Therapy.

Unexpected Extracardiac Multifocal Adult Rhabdomyomas With 10 Lesions of the Head and Neck: Epidemiology, Diagnosis, and Therapy.

J Oral Maxillofac Surg. 2017 Sep 29;:

Authors: Lu H, Liu S, Yang W, Zhang C

Abstract
Adult rhabdomyomas (ARMs) are rare solitary benign neoplasms of the head and neck, and multifocal ARMs are even rarer. Owing to the low incidence and scanty knowledge of this peculiar entity, several patients have been reported to be misdiagnosed or overtreated. This report describes a patient with multifocal ARMs with as many as 10 synchronous lesions. In addition, all published cases of this entity in PubMed, Embase, and Web of Science databases were reviewed up to March 1, 2017. Overall, 10 of 29 reported cases had more than 2 lesions, with a maximum of 10 synchronous masses in the present report. Multifocal ARMs usually present as slow-growing lumps in the parapharyngeal region, with a predilection for older men. Treatments of multifocal ARMs should be tailored and close follow-up is recommended for tiny lesions located in vital structures. In addition, multifocal ARMs should be differentially diagnosed from other multifocal lesions in the head and neck region to avoid aggressive excision and produce a favorable outcome for patients.

PMID: 29106891 [PubMed - as supplied by publisher]

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Functional Anatomic Computer Engineered Surgery Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton.

Functional Anatomic Computer Engineered Surgery Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton.

J Oral Maxillofac Surg. 2017 Oct 14;:

Authors: Khatib B, Cuddy K, Cheng A, Patel A, Sim F, Amundson M, Gelesko S, Bui T, Dierks EJ, Bell RB

Abstract
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PMID: 29106889 [PubMed - as supplied by publisher]

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Acquired Vascular Tumors of the Head and Neck.

Acquired Vascular Tumors of the Head and Neck.

Otolaryngol Clin North Am. 2017 Oct 26;:

Authors: Persky M, Tran T

Abstract
Vascular neoplasms of the head and neck present with a wide spectrum of signs and symptoms. Diagnosis requires a high index of suspicion and is usually made after tumors are large enough to be visually apparent or cause symptoms. This article discusses the most common acquired benign and malignant vascular tumors, with an emphasis on their evaluation and treatment.

PMID: 29106888 [PubMed - as supplied by publisher]

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Routine pathologic examination of tonsillectomy specimens: A 10-year experience at a tertiary care children's hospital.

Routine pathologic examination of tonsillectomy specimens: A 10-year experience at a tertiary care children's hospital.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:86-89

Authors: Bizzell JG, Richter GT, Bower CM, Woods GL, Nolder AR

Abstract
OBJECTIVE: To review histopathologic diagnoses from tonsillectomy specimens and determine whether routine pathologic exam is necessary.
METHODS: Pathology reports of patients undergoing tonsillectomy from 2005 to 2014 at our pediatric tertiary care hospital were reviewed. Histopathologic diagnoses were recorded with special attention to identification of malignancy.
RESULTS: A total of 8807 paired tonsil specimens were sent to pathology over a 10-year course. Gross analysis was performed on all. Microscopic histopathologic analysis was performed on 612 (6.95%) specimens with all but one demonstrating strictly reactive lymphoid hyperplasia. The single specimen (0.16%) demonstrated follicular hyperplasia with focal necrotizing granulomatous lymphadenitis without organisms identified on special staining. The surgeon requested pathologic diagnosis to rule out lymphoma in 4 of 8087 (0.05%) of the specimens. No malignancies were identified. The approximate charges for gross examination of a paired tonsillectomy specimen and microscopic examination were $136.10 and $294.54, respectively. Over the 10 year period of the study, total charges were estimated at $1,115,340 (gross) and $180,258 (microscopic).
DISCUSSION: Microscopic analysis of tonsil specimens is unlikely to identify abnormal pathology that changes patient management. This study suggests that neither gross nor microscopic pathologic examination of tonsillectomy specimens is necessary on a routine basis. Histologic analysis of tonsils should be requested only on a case by case basis when clinical suspicion for malignancy is high. Avoiding routine pathologic exam of tonsils may be cost effective and medically safe.

PMID: 29106883 [PubMed - in process]

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GJB2 mutations: Genotypic and phenotypic correlation in a cohort of 690 hearing-impaired patients, toward a new mutation?

GJB2 mutations: Genotypic and phenotypic correlation in a cohort of 690 hearing-impaired patients, toward a new mutation?

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:80-85

Authors: Leclère JC, Le Gac MS, Le Maréchal C, Ferec C, Marianowski R

Abstract
OBJECTIVES: To analyze the clinical features of hearing impairment and to search for correlations with the genotype in patients with GJB2 mutations.
DESIGN: Case series.
SETTING: Collaborative study in referral centers, institutional practice.
PATIENTS: A total of 690 hearing-impaired patients were genotypically and phenotypically described. The mutations of GJB2 and GJB6 were studied. Heterozygous patients were searched for another mutation by microsatellite approach.
MAIN OUTCOME MEASURES: Prevalence of GJB2 mutations, microsatellite approach, hearing-impairment.
RESULTS: In 498 patients (72,17% of the cohort), no mutation was found. Homozygotous patients were 59 (8,55%), with 51 for c.35delG, 6 for p.M34T and 2 for GJB6. Compound heterozygous were 64 (9,28%) with 56 c.35delG-others mutations. Genotypes with biallelic non sense mutations had a high risk of severe to profound hearing impairment. It was frequently milder in compound heterozygotes than in c.35delG homozygotes. Heterozygous patients were 69 (10%) with 21 c.35delG, 20 p.M34T and 28 others mutations. We selected patients with a complete historical medical file (clinical and audiometric data). Then, we performed a microsatellite approach (multiplex PCR of short DNA fragments) to localize a new pathologic allele. Seventeen heterozygous patients were studied. Six patients (35%) showed the same haplotype. They were compound heterozygous bearing a new pathologic allele.
CONCLUSION: Genotype may affect deafness severity, but environmental and other genetic factors may also modulate the severity and evolution of GJB2-GJB6 deafness. A new haplotype for GJB2 is described but the exact mutation remains unknown.

PMID: 29106882 [PubMed - in process]

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Variations in electrode impedance during and after cochlear implantation: Round window versus extended round window insertions.

Variations in electrode impedance during and after cochlear implantation: Round window versus extended round window insertions.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:44-48

Authors: Wang J, Sun J, Sun J, Chen J

Abstract
OBJECTIVES: To assess differences in intra- and postoperative electrode impedances following cochlear implantation between round window insertions (RWI) and extended round window insertions (ERWI).
METHODS: Fifty patients with congenital hearing loss received unilateral hearing implants (Sonata Ti100, Med-El GmbH, Innsbruck, Austria) with standard electrode arrays. The patients were divided into two groups according to the surgical technique used. Thirty-five procedures were performed with RWI (group A) and 15 with ERWI (group B). Electrode impedance was measured and analysed during the operation, and one week and one month postoperatively.
RESULTS: There were no statistically significant differences (i.e., P > 0.05) in electrode impedance between groups A and B intraoperatively, or at one week or one month postoperatively. Electrode impedance at one month postoperatively was higher than the intraoperative and postoperative one week values in group A (P < 0.05), with similar results in group B.
CONCLUSION: There was no significant difference between RWI and ERWI in operative duration or complications of cochlear implantation. Moreover, no significant differences in postoperative electrode impedance values were found between the two surgical routes.

PMID: 29106874 [PubMed - in process]

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Pediatric tympanic membrane cholesteatoma: Systematic review and meta-analysis.

Pediatric tympanic membrane cholesteatoma: Systematic review and meta-analysis.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:21-27

Authors: Ching HH, Spinner AG, Ng M

Abstract
INTRODUCTION: Tympanic membrane cholesteatoma (TMC) is a rare anomaly found in pediatric patients with no significant otologic history. Its pathogenesis appears distinct from congenital mesotympanic cholesteatoma. This systematic review and meta-analysis evaluates the management of TMC.
METHODS: Two authors independently conducted a systematic review using the PubMed-NCBI, Cochrane Library, and Web of Science databases. Studies describing cases of pediatric TMC were included. Patients with history of chronic otitis, otorrhea, trauma, or otologic surgery were excluded.
RESULTS: Seventeen articles were included for a total of 45 patients. Mean age was 35.9 months with 56% female. Patients aged ≥36 months had significantly larger cholesteatomas than younger patients (4.2 vs 1.9 mm, p = 0.004). Nine patients (20%) had middle ear extension but none had middle ear or ossicular disease. CT scans influenced management in 1 of 26 patients. All patients were managed surgically by transcanal approach (93%) or retroauricular approach (7%). Surgery involved enucleation without TM perforation (80%) or complete excision with TM grafting (20%). In 23 patients, the fibrous TM remained intact, and there were no recurrences in this group at a mean follow-up of 11 months. Overall, there was 1 recurrence (2%), eventually requiring reoperation. No patients experienced persistent tympanic membrane perforation, chronic otitis, or hearing loss.
CONCLUSION: TMC occurs in pediatric patients without an otologic history. Associated middle ear involvement has not been reported. CT scanning may not be necessary for work up and management of this disorder. A transcanal approach with enucleation is often sufficient treatment. Risk of recurrence appears lower than with congenital mesotympanic cholesteatoma.

PMID: 29106870 [PubMed - in process]

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Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation.

Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:160-168

Authors: Yamamoto R, Naito Y, Tona R, Moroto S, Tamaya R, Fujiwara K, Shinohara S, Takebayashi S, Kikuchi M, Michida T

Abstract
OBJECTIVES: An effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs.
METHODS: The study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility < 80% with the 1st CI).
RESULTS: We found evidence of the McGurk effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI.
CONCLUSION: Our results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural listening (with Bi-CIs). Overall, the findings of this study might be used to inform future research to identify the best strategies for speech training using AV integration effectively in prelingually deafened children.

PMID: 29106867 [PubMed - in process]

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An investigation of operative outcomes: Pediatric invasive fungal sinusitis.

An investigation of operative outcomes: Pediatric invasive fungal sinusitis.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:142-147

Authors: Hanba C, Svider PF, Lai W, Raza SN, Sheyn A, Eloy JA, Folbe AJ

Abstract
OBJECTIVES/HYPOTHESIS: Invasive fungal sinusitis is an uncommon entity among children. Early recognition is crucial for facilitating successful treatment with minimal morbidity. The goal of this analysis was to identify patient characteristics associated with high-risk surgical disease through a population-based examination into this rare and deadly disease process.
METHODS: A retrospective chart review of the 2009 and 2012 Kids' Inpatient Database (KID) was conducted. A series of queries (Fungal infection→immunocompromised diagnosis→sinus procedure) identified 102 patients with likely invasive fungal sinusitis. Outcomes included: species, invasive extension, death, and other clinical characteristics.
RESULTS: Patients with leukemia/lymphoma constituted 90.2% of individuals evaluated in this analysis. Nearly a quarter of pediatric patients receiving surgical treatment for invasive fungal sinusitis died during their hospital stay -24.9%. Aspergillus was the most commonly recorded mycotic species. Average hospital stay was 59.3 days, and associated hospital costs averaged $746,299 per stay. Patients 0-5 years old were more likely to have orbital involvement -56.3%. Brain extension was noted in 33.7% of this cohort as well. Mucormycosis was an independent predictor of death (p = 0.03), with an odds ratio of 3.835.
CONCLUSION: To the best of our knowledge, this is the largest pediatric cohort with invasive fungal sinusitis in the literature. Patient demographics, cytology, and disease extension offer predictive information regarding patient outcomes for invasive fungal sinusitis. A high clinical suspicion and early treatment may decrease the lengthy and costly hospitalizations in this population.

PMID: 29106862 [PubMed - in process]

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Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO2 laser approach.

Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO2 laser approach.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:123-126

Authors: Morand GB, Lambercy K, Guilcher P, Sandu KB

Abstract
IMPORTANCE: Oesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser.
OBSERVATIONS: Pharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up.
CONCLUSION AND RELEVANCE: Pharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.

PMID: 29106858 [PubMed - in process]

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HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis.

HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:119-122

Authors: Zhao J, Wang G, Wang G, Wang H, Wang S, Tai J, Tang L, Gui J, Zhang J, Ni X

Abstract
Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is a rare benign neoplasm of the respiratory mucosa caused by human papilloma virus. Previous studies on the possible associations between HLA alleles and JORRP have shown various results in different ethnic groups. The present study aims to investigate the association between JORRP and HLA class II DRB1and DQB1 alleles in Chinese Han children. We found that the frequencies of HLA-DRB1*03:01 (pc = 0.0378, OR = 4.8) and HLA-DQB1*02:01 (pc = 0.021, OR = 4.8) alleles were significantly higher in patients with JORRP than in controls. In addition, HLA-DRB1*03:01 allele significantly correlated with aggressive JORRP (r = 0.467, p = 0.009). This was the first study on the HLA alleles in Chinese Han patients with JORRP. Future studies are required to further elucidate the correlation of HLA class II alleles and susceptibility to JORRP.

PMID: 29106857 [PubMed - in process]

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Genetic analysis of a Chinese family with members affected with Usher syndrome type II and Waardenburg syndrome type IV.

Genetic analysis of a Chinese family with members affected with Usher syndrome type II and Waardenburg syndrome type IV.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:114-118

Authors: Wang X, Lin XJ, Tang X, Chai YC, Yu DH, Chen DY, Wu H

Abstract
AIMS: The purpose of this study was to identify the genetic causes of a family presenting with multiple symptoms overlapping Usher syndrome type II (USH2) and Waardenburg syndrome type IV (WS4).
METHODS: Targeted next-generation sequencing including the exon and flanking intron sequences of 79 deafness genes was performed on the proband. Co-segregation of the disease phenotype and the detected variants were confirmed in all family members by PCR amplification and Sanger sequencing.
RESULTS: The affected members of this family had two different recessive disorders, USH2 and WS4. By targeted next-generation sequencing, we identified that USH2 was caused by a novel missense mutation, p.V4907D in GPR98; whereas WS4 due to p.V185M in EDNRB. This is the first report of homozygous p.V185M mutation in EDNRB in patient with WS4.
CONCLUSION: This study reported a Chinese family with multiple independent and overlapping phenotypes. In condition, molecular level analysis was efficient to identify the causative variant p.V4907D in GPR98 and p.V185M in EDNRB, also was helpful to confirm the clinical diagnosis of USH2 and WS4.

PMID: 29106856 [PubMed - in process]

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Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey.

Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:108-113

Authors: El Rassi E, de Alarcon A, Lam D

Abstract
OBJECTIVES: To evaluate practice patterns amongst pediatric otolaryngologists in the management of post-tonsillectomy hemorrhage.
METHODS: A cross-sectional survey of the American Society of Pediatric Otolaryngology membership was administered electronically. The survey contained questions related to practice type, availability of resident and fellow call coverage, and management of different scenarios of post-tonsillectomy hemorrhage. Anonymous responses were collected and tabulated.
RESULTS: The response rate was 157/443 (35%). For patients presenting with a convincing history of post-tonsillectomy hemorrhage but no clot or bleeding on exam, the most common management was overnight observation (55%) or discharge home with close follow-up (29%). In patients presenting with tonsillar clot but no active bleeding, the most common management was operating room for control (50%), followed by observation (25%) and bedside topical treatment (13%). In the same scenario with a cooperative teenager, bedside topical treatment was most common (45%), followed by operating room for control (27%) and observation (16%). In patients presenting with active tonsillar bleeding, operating room for control was most common (83%) while few (6%) attempted bedside treatment. If the patient was a cooperative teenager, 38% attempted bedside treatment while 52% would still go to the operating room.
CONCLUSIONS: There is substantial variation in the management of post-tonsillectomy hemorrhage amongst the pediatric otolaryngologists. Further studies to determine outcomes associated with differing treatment strategies would be useful in establishing practice recommendations.

PMID: 29106855 [PubMed - in process]

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I ragazzi del Progetto Giovani della Pediatria dell'INT presentano il loro fumetto

«Loop .Indietro non si torna»
14 novembre 2017 - ore 11.00
Aula Magna G. Bonadonna
Istituto Nazionale dei Tumori
Via Venezian, 1 - 20133, Milano

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Review of Cardiometabolic Effects of Prescription Omega-3 Fatty Acids

Abstract

Purpose of Review

Populations with significant dietary fish intake tend to have lower cardiovascular (CV) risk and demonstrable physiologic differences including lower lipid/lipoprotein levels and other direct and indirect effects on the arterial wall and inhibiting factors that promote atherosclerosis. Treatment with high doses of pharmacologic-grade omega-3 fatty acid (n-3FA) supplements achieves significant reductions in triglycerides (TG), non-high-density lipoprotein- (non-HDL-) and TG-rich lipoprotein- (TRL-) cholesterol levels. n-3FA supplements have significant effects on markers of atherosclerosis risk including endothelial function, low-density lipoprotein (LDL) oxidation, cellular and humoral markers of inflammation, hemodynamic factors, and plaque stabilization. This review summarizes the lipid and cardiometabolic effects of prescription-grade n-3FAs and will discuss clinical trials, national/organizational guidelines, and expert opinion on the impact of supplemental n-3FAs on CV health and disease.

Recent Findings

Clinical trial evidence supports use of n-3FAs in individuals with established atherosclerotic cardiovascular disease (ASCVD), but the data either does not support or is lacking for other types of cardiometabolic risk including prevention of stroke, treatment in patients with heart failure, diabetes mellitus and prediabetes, and for primary prevention in the general population.

Summary

Despite inconsistent findings to support widespread benefit, there is persistent population-wide enthusiasm for n-3FA as a dietary supplement for its cardiometabolic benefits. Fortunately, there are ongoing clinical trials to assess whether the lipid/lipoprotein benefits may be extended to other at-risk populations and whether lower-dose therapy may provide background benefit for primary prevention of ASCVD.

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Early Rehabilitation After Stroke: a Narrative Review

Abstract

Purpose of Review

Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain’s dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits.

Recent Findings

Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge.

Summary

The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.

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Cardiovascular Risk Factors After Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): a New Effective Therapeutic Approach?

Abstract

Obesity and its associated comorbidities entail a significantly increased cardiovascular mortality. Therefore, approaching obesity control must include among its aims the reduction of the associated comorbidities and the higher cardiovascular mortality risk and not only weight loss. Many observational studies indicate that bariatric surgery (BS) is associated with a better long-term survival than standard care. Furthermore, in general, these epidemiological studies included patients who underwent gastric bypass (GB), not biliopancreatic diversion/duodenal switch (BPD/DS), so the potential additional benefit of this latter technique remains unknown. In this regard, in theory, derivative techniques are usually associated to a higher rate of long-term improvement of metabolic comorbidities, so their potential impact on cardiovascular morbidity and mortality could be even greater than what has been published up to date. In 2007, our group proposed a simplification of the bariatric technique based on the duodenal switch, which we termed “single anastomosis duodeno-ileal bypass with sleeve gastrectomy” or SADI-S. In this review, and 10 years later, we describe some of the main results of those patients who underwent this procedure, specifically regarding their outcome on metabolic comorbidities and cardiovascular risk. Considering the findings presented in this review, in which a significant improvement of all metabolic comorbidities was observed, we may confidently suggest that SADI-S seems comparable to a BPD/DS procedure in the mid-term outcome. After all, the SADI-S procedure was conceived as a simplified version of the BPD/DS technique and not necessarily intended to maximize the improvement of cardiovascular and metabolic comorbidities, which is already sufficiently optimal. In this regard, in our experience, we have encountered a new satisfactory result, which combines more pros than cons. In fact, as we have seen, after a follow-up of 3 years, the outcomes of weight loss and improvement of blood pressure, lipid profile, and insulin resistance seem to be better with SADI-S than with Roux-en-Y gastric bypass (RYGB), and this difference may be probably still relevant in the long-term evaluation. Summary: Mid-term follow-up of patients who underwent SADI-S has proven that this procedure seems, at least, as effective as other malabsorptive techniques such as BPD/DS and significantly reduces the four main cardiovascular risk factors to a higher extent than RYGB. One of the main advantages inherent to this intervention modality is that it truly simplifies any of the prior derivative procedures and that it may be specifically adapted and individualized to each patient, according to his BMI and associated metabolic comorbidities.

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health technology; +290 new citations

290 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

health technology

These pubmed results were generated on 2017/11/07

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Paediatric Endocrinology Subspecialty – The European Map, 55 Years Later

Horm Res Paediatr

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Evaluation of Mayer-Rokitansky-Küster-Hauser syndrome with magnetic resonance imaging: Three patterns of uterine remnants and related anatomical features and clinical settings

Abstract

Objective

To characterize the anatomical features and clinical settings of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and correlate them with patterns of uterine involvement.

Methods

Pelvic magnetic resonance images and medical records of 92 MRKH patients were retrospectively reviewed. Patients were subgrouped by uterine morphology: uterine agenesis, unilateral rudimentary uterus and bilateral rudimentary uteri. Uterine volume, presence of endometrium, location of ovary, endometriosis and pelvic pain were compared among groups.

Results

The mean uterine volume was 33.5 ml (17.5–90.0 ml) for unilateral uterine remnants, and 16.1 ml (3.5–21.5 ml) for bilateral uterine rudiments (p<0.01). The incidence of presence of endometrium (100% vs. 22%, p<0.001), haematometra (56% vs. 3%, p<0.001) and ovarian endometriosis (22% vs. 3%, p<0.01) was significantly increased in the group of unilateral rudimentary uteri as compared with the group of bilateral uterine remnants. Thirty-one patients (38%) showed ectopic ovaries. Pelvic pain was more common in individuals with unilateral rudimentary uterus than those who had no (56% vs. 5%, p<0.01) or bilateral uterine remnants (56% vs. 14%, p<0.05).

Conclusion

MRKH patients with different patterns of uterine involvement may have differentiated anatomical features and clinical settings.

Key Points

• Rudimentary uteri, especially bilateral rudimentary uteri, were quite common in MRKH syndrome.

• Uterine remnants can be relatively large, especially the unilateral rudimentary uterus.

• Presence of endometrium and related complications are not rare in MRKH syndrome.

• Existence of endometrium and complications are more frequent in unilateral rudimentary uterus.

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Apparent diffusion coefficient maps obtained from high b value diffusion-weighted imaging in the preoperative evaluation of gliomas at 3T: comparison with standard b value diffusion-weighted imaging

Abstract

Objective

To assess whether ADC maps obtained from high b value DWI were more valuable in preoperatively evaluating the grade, Ki-67 index and outcome of gliomas.

Methods

Sixty-three patients with gliomas, who underwent preoperative multi b value DWI at 3 T, were enrolled. The ADC₁₀₀₀, ADC₂₀₀₀ and ADC₃₀₀₀ maps were generated. Receiver operating characteristic analyses were conducted to determine the area under the curve (AUC) in differentiating high-grade gliomas (HGG) from low-grade gliomas (LGG). Pearson correlation coefficients (R value) were calculated to investigate the correlation between parameters with the Ki-67 proliferation index. Survival analysis was conducted by using Cox regression.

Results

The AUC of the mean ADC₁₀₀₀ value (0.820) was lower than that of the mean ADC₂₀₀₀ value (0.847) and mean ADC₃₀₀₀ value (0.875) in differentiating HGG from LGG. The R value of the mean ADC₁₀₀₀ value (−0.499) was less negative than that of the mean ADC₂₀₀₀ value (−0.530) and mean ADC₃₀₀₀ value (−0.567). The mean ADC₃₀₀₀ value was an independent prognosis factor for gliomas (p = 0.008), while the mean ADC₁₀₀₀ and ADC₂₀₀₀ values were not.

Conclusion

ADC maps obtained from high b value DWI might be a better imaging biomarker in the preoperative evaluation of gliomas.

Key Points

• ADC ₃₀₀₀maps could improve the differentiation between HGG and LGG.

• The mean ADC ₃₀₀₀value had a closer correlation with the Ki-67 index.

• The mean ADC ₃₀₀₀value was an independent prognosis factor for gliomas.

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Evaluating anorexia-related brain atrophy using MP2RAGE-based morphometry

Abstract

Aim

To evaluate brain atrophy in anorexic patients by automated cerebral segmentation with the magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) MRI sequence.

Material and methods

Twenty patients (female; mean age, 27.9 years), presenting consecutively for brain MRI between August 2014–December 2016 with clinical suspicion of anorexia nervosa and BMI<18.5 kg/m² were included. Controls were ten healthy females (mean age, 26.5 years). Automated brain morphometry was performed based on MP2RAGE. Means of morphometric results in the two groups were compared and correlation with BMI was analysed.

Results

Significantly lower volumes of total brain, grey matter (GM), white matter (WM), cerebellum and insula were found in anorexic patients. Anorexics had higher volumes of CSF, ventricles, lateral ventricles and third ventricle. When adjusted means for weight and height were compared, the volume of WM and cerebellum were not significantly different. However, volume of WM was significantly affected by weight and positively correlated with BMI. Significant positive correlations were found between BMI and volumes of total brain, GM, cortical GM and WM. BMI was negatively correlated with volumes of CSF and third ventricle.

Conclusion

Brain atrophy was demonstrated in anorexic patients with MP2RAGE-based automated segmentation, which seems to reliably estimate brain volume.

Key points

• Automated brain segmentation based on 3-D MRI seems to reliably estimate brain volume.

• This technique detected brain atrophy in patients suffering from anorexia nervosa.

• Brain changes in anorexia nervosa can be quantitatively and qualitatively followed-up by MRI.

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The relationship of cancer characteristics and patient outcome with time to lung cancer diagnosis after an abnormal screening CT

Abstract

Purpose

The National Lung Screening Trial (NLST) demonstrated a reduction in lung cancer and all-cause mortality with low-dose CT (LDCT) screening. The aim of our study was to examine the time to diagnosis (TTD) of lung cancer in the LDCT arm of the NLST and assess its relationship with cancer characteristics and survival.

Methods

The subjects (N = 462) with a positive baseline screen and subsequent lung cancer diagnosis within 3 years were evaluated by data and image review to confirm the baseline abnormality. The cases were analysed for the relationship between TTD and imaging features, cancer type, stage and survival for 7 years from baseline screen.

Results

Cancer was judged to be present at baseline in 397/462 cases. The factors that showed significant association (p value trend less than 0.05) with longer TTD included smaller nodule size, pure ground glass nodules (GGNs), smooth/lobulated margins, stages I/II, adenocarcinoma, and decreasing lung cancer mortality. The logistic regression model for lung cancer death showed significant inverse relationships with size less than 20 mm (OR = 0.32), pure GGNs (OR = 0.24), adenocarcinoma (OR = 0.57) and direct relationship with age (OR = 1.4).

Conclusion

TTD after a positive LDCT screen in the NLST showed a strong association with imaging features, stage and mortality.

Key Points

• NLST observed variable time to lung cancer diagnosis from positive baseline screen.

• Time to diagnosis was associated with imaging features, cancer type and stage.

• In univariate but not multivariate analysis, longer TTD correlated with decreased mortality.

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Τρίτη 7 Νοεμβρίου 2017

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